CHOOSING AN ANTIDEPRESSANT
With so many antidepressants on the market, choosing an antidepressant can often be a confusing task. Choosing an antidepressant becomes a pressing issue when you consider that there is a good chance you or someone you know and care about suffers from, or has suffered from depression. Significant depression affects 16 percent of the U.S. population at some point in their lives.
There are so many new medications out there now to help. They all work on one or another brain chemical, whether it’s serotonin, norepinephrine, or dopamine.
They are marketed with fierceness, all fighting for a piece of the lucrative depression pie. The competition only serves to make the task of choosing an antidepressant all the more confusing. Is one antidepressant really better than the others?
There are many antidepressants on the market, but there may not be much of a difference between them when it comes to effectiveness, says latest research.
Significant depression affects 16 percent of the U.S. population at some point in their lives. There are so many new medications out there now to help. They all work on one or another brain chemical, whether it’s serotonin, norepinephrine, or dopamine. They are marketed with fierceness, all fighting for a piece of the lucrative depression pie. Is one antidepressant really better than the others?
The latest research in the Annals of Internal Medicine combined the results of smaller previous studies looking at the effectiveness of the most commonly used class of antidepressants, the SSRIs, These are the serotonin reuptake inhibitors, which increase the amount of serotonin in the brain, and others, including Wellbutrin, Cymbalta, and Effexor, which act on other hormones, like norepineprhine and dopamine.
Overall, this large analysis found there are, in general, no significant differences in antidepressant medication effectiveness; they all work just about the same, and no one drug works any faster than the others.
Dr. David Hellerstein, the Director of the Mood Disorders Research Center at St. Luke’s Roosevelt Hospital Center, New York, says, “The reason for choosing one antidepressant over another may be because the side effects might be a little bit different in one person than another, and you want to match the patient with the side effects. Just because all the antidepressants work in the same percentage of people doesn’t mean they’re all identical. So let’s say one person chooses an antidepressant like Paxil which is an SSRI, and finds they’re very sedated or have sexual side effects or weight gain. It might be possible to switch them to a different antidepressant which would have a lower likelihood of having those side effects.”
For example, among the SSRIs, Paxil showed the most frequent weight gain; Prozac had the least. Wellbutrin also has low weight gain, and low sexual side effects, but it has the highest frequency of associated headaches and insomnia. Still, in spite of these differences, the overall frequency of side effects was about the same.
And although antidepressant medications don't cure depression, regardless of the drug chosen, all of them can help eliminate or nearly completely reduce symptoms including sadness, anxiety, depression-related sleep and appetite problems, difficulty concentration, and fatigue.
“For any person the chance of any antidepressant working is about two out of three. If a person doesn’t respond to one antidepressant, you can pick a second antidepressant and the chances are probably 2 out of 3 they’ll respond to the second one,” says Dr. Hellerstein.
For the second drug the doctor might choose an antidepressant that has a different target of action. For instance, if you’re on an SSRI which acts on serotonin, the doctor might switch you to Wellbutrin which acts instead on dopamine and norepiniephrine in the brain.
The American Psychiatric Association says choose an antidepressant first based on the side effects that concern the patient, and then basically, it’s a cost issue.
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